What is the most common other substance use disorder in older adults with opioid use disorders?

Oct 4, 2025 3 min read •

mental health Geriatric Health Substance Use Disorder

According to the National Institute on Drug Abuse, the prevalence of substance use disorders among older adults is a growing concern, particularly when combined with opioid use disorders (OUD). This population faces unique risks, making the identification of co-occurring conditions vital. Understanding what is the most common other substance use disorder in older adults with opioid use disorders is the first step toward comprehensive care.

Quick Summary

The most prevalent co-occurring substance use disorder among older adults with opioid use disorders is often alcohol use disorder, followed closely by the misuse of prescription benzodiazepines. This combination presents significant health risks and requires specialized, integrated treatment plans.

Key Points

Alcohol Use is Most Common: Among older adults with OUD, alcohol use disorder is the most prevalent co-occurring substance use disorder, increasing the risk of overdose and organ damage.
Benzodiazepine Misuse is a Major Risk: The second most common is the misuse of benzodiazepines, often stemming from prescriptions, leading to severe respiratory depression when combined with opioids.
Seniors Face Unique Dangers: Aging bodies are highly susceptible to the amplified sedative effects and cognitive impairment caused by polysubstance use.
Integrated Care is Essential: Treatment for older adults with co-occurring disorders requires an integrated approach that addresses all substance use issues simultaneously.
Diagnosis is Complex: Screening for polysubstance use in seniors is challenging due to overlapping symptoms and social stigma.

A rising challenge: Polysubstance use in older adults

For older adults, substance use disorders (SUD) are often overlooked or misdiagnosed, mistaken for symptoms of aging or other medical conditions. This diagnostic challenge is compounded when dealing with polysubstance use, particularly for those with opioid use disorder (OUD). The interaction between opioids and other substances can be especially dangerous in an aging body, which often has reduced drug metabolism, heightened sensitivity, and pre-existing health issues.

Alcohol: The leading co-occurring substance

Several studies indicate that alcohol use disorder consistently ranks as the most common co-occurring substance use disorder among older adults with an existing OUD. This high prevalence can be attributed to several factors, including social and emotional triggers, long-standing habits, and accessibility.

The deadly synergy of alcohol and opioids

When combined, alcohol and opioids—both central nervous system depressants—create a heightened risk of serious health consequences, including fatal overdose, increased risk of accidents, and exacerbation of medical conditions.

Benzodiazepines: The second most prevalent co-occurring substance

Following alcohol, the misuse of benzodiazepines, such as alprazolam, lorazepam, and diazepam, is the second most common co-occurring substance use disorder in older adults with OUD. This specific comorbidity is largely linked to the high rates of prescription benzodiazepines among seniors for conditions like anxiety and insomnia.

The prescription factor and heightened risks

Combining opioids and benzodiazepines creates additive sedative effects, significantly increasing the risk of overdose, respiratory failure, and cognitive and functional decline. This combination can also complicate withdrawal.

Screening and diagnosis challenges

Diagnosing polysubstance use in older adults is complex due to the overlap of symptoms with other health conditions, social stigma, and the management of multiple prescriptions. Standardized questionnaires, urine drug screens, and an interdisciplinary evaluation can aid in identification.

Understanding the spectrum of co-occurring disorders

Beyond alcohol and benzodiazepines, other substances can be involved in co-occurring disorders in older adults. The following table provides a comparison of common co-occurring substances and their associated risks in older adults with OUD.


Substance	Primary Mode of Acquisition	Key Risk with Opioids in Older Adults
Alcohol	Legal access, lifelong habit	Respiratory depression, liver damage, fatal overdose, falls
Benzodiazepines	Frequent prescriptions for anxiety/sleep	Severe respiratory depression, cognitive decline, addiction
Cannabis	Recreational or medicinal use	Increased sedation, cognitive effects, drug interactions
Stimulants	Diverted prescriptions, illicit sources	Cardiovascular strain, heart attack, stroke, psychological effects

Integrated treatment strategies for older adults

Effective treatment for OUD with co-occurring SUDs in older adults requires a specialized and integrated approach. This includes comprehensive assessment, careful medication management (including MAT), and behavioral therapies like CBT and Motivational Interviewing.

The importance of a supportive environment

For many older adults, recovery is heavily influenced by their living situation and social connections. Addressing issues like isolation, grief, and housing stability is a crucial part of the recovery process. Integrated care, including mental health and social work services, is vital to providing holistic support. For more resources on aging and mental health, the National Institute on Aging offers comprehensive information and research (https://www.nia.nih.gov/).

Conclusion

Alcohol use disorder is the most common co-occurring substance use disorder among older adults with OUD, followed by the misuse of benzodiazepines. These combinations pose significant health risks. Effective care requires recognizing this complexity and providing integrated treatment that addresses all dependencies, comorbidities, and psychosocial factors to improve outcomes and quality of life.

Frequently Asked Questions

Alcohol misuse often stems from emotional triggers, long-standing habits, and easy access, which may go unnoticed by healthcare providers.

Both are central nervous system depressants, and their combined sedative effects are amplified, significantly increasing the risk of respiratory failure, overdose, and death.

Providers can use standardized screening tools, conduct thorough interviews, be aware of subtle signs, and utilize an interdisciplinary team approach.

Yes, specialized geriatric-focused programs integrate medical care, medication management, and behavioral therapies tailored to older adults' needs.

Key barriers include social stigma, shame, lack of provider awareness, and challenges in accessing specialized care.

MAT is vital but must be managed cautiously under medical supervision for patients with polysubstance use, especially with benzodiazepines, to prevent dangerous interactions.

The risk is significantly higher due to the body's reduced ability to metabolize these substances, meaning smaller doses can lead to overdose more easily.

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.